Implementation of a tele-thrombolysis service for acute stroke patients of the Manning Rural Referral Hospital: A quasi-experimental study

Background: Thrombolysis is the most effective treatment for acute ischemic stroke but strict guidelines around patient assessment and treatment time frames mean patients in rural areas often miss out. Telemedicine is recommended for increasing access to stroke thrombolysis in rural areas. Aim: To design, implement and evaluate tele-thrombolysis service with the aim of increasing stroke thrombolysis rates. Method: A tele-thrombolysis service was implemented, linking a rural (spoke) and tertiary (hub) hospital in NSW. After 4 months the service was evaluated for feasibility and preliminary efficacy, safety and efficiency. Consecutive suspected stroke patients presenting to the spoke hospital were compared to a historical cohort identified via retrospective chart audit for matched time epochs. Thrombolysis rates for ischemic stroke patients in the spoke catchment for the pre and post implementation periods were compared. Rates ofsymptomatic intracranial haemorrhage, 30 day modified Rankin scale scores, door-CT, door-needle and onset-needle times were compared to published tele-thrombolysis and face-to-face thrombolysis results. Results: 10 patients were assessed via tele-consultation and 2 subsequently received thrombolysis equating to an increase in thrombolysis rates from 3.2% to 8% (Fisher's exact p = 0.581) for the pilot period. Of the patients treated neither suffered a sICH and both achieved a 30 day mRS of 2. The median Door – CT time was 48 mins (range 1–211) and Door – Treatment times were 88 and 152 mins. Conclusion: The tele-thrombolysis service, the first of its kind in NSW, successfully increased thrombolysis rates in the Manning area without any adverse effects. Continued recruitment and evaluation is needed to truly assess the effect of the service on thrombolysis rates and its safety and efficiency.